A systematic review with meta-analysis of the olfactory fossa anatomy: Implications for anterior skull base approaches
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Updated: Jan 18, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
George Triantafyllou1,2, Ibrahim Alzir1, Nektaria Karangeli1
1Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias str, Goudi, Athens, 11527, Greece.
Background:
The anterior cranial fossa, and specifically the olfactory fossa (OF), is a region of critical importance in skull base surgery due to its complex and variable anatomy.
Methods:
This systematic review and meta-analysis aimed to evaluate the depth of the OF based on the Keros (1962) classification system and to estimate the pooled prevalence of each type.
Results:
A total of 40 imaging-based studies involving 17,078 skull sides were included. The pooled mean OF depth was 4.99 mm, corresponding to Keros type II, which was also the most common type with a prevalence of 66.13%, followed by type I at 22.50% and type III at 9.15%. Anatomical variation was influenced by geographical distribution, imaging modality, and age group.
Conclusions:
The findings underscore the need for thorough preoperative imaging, as the identification of OF depth, symmetry, and surrounding anatomical features is essential for safe endoscopic and transcranial approaches. The study emphasizes the relevance of incorporating evidence-based anatomical knowledge into surgical planning to minimize the risk of complications such as cerebrospinal fluid leakage and intracranial injury.
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